Portal Park RFQ.pdf

Bulloch County Board of Commissioners Request for Qualifications

To Provide

Professional Design Implementation Services

For

Portal Park

Solicitation Issue Date: 8/6/2026

Qualifications Packages Due: 9/3/2026

TABLE OF CONTENTS

PHASE I – REQUEST FOR QUALIFICATIONS (RFQ)

1. GENERAL PROJECT INFORMATION

2. DESIGN PROFESSIONAL SERVICES REQUIREMENTS

3. SCOPE OF SERVICES

4. QUALIFICATIONS REVIEW PROCESS

5. SCHEDULE OF EVENTS (PHASE I)

6. SUBMITTAL OF QUESTIONS AND REQUESTS FOR QUALIFICATIONS

7. INSTRUCTIONS FOR PREPARING STATESMENTS OF QUALIFICATIONS

8. SUBMITTAL OF STATEMENTS OF QUALIFICATIONS

9. FINALIST NOTIFICATION

10. MANDATORY FORMS

a. Form A: Non-collusion Affidavit

b. Form B: Bidder Declaration

c. Form C: Contractor Affidavit

d. Form D: Sub-contractor Affidavit (if applicable)

PHASE 1

REQUEST FOR QUALIFICATIONS

Professional Design Implementation Services

For

Portal Park

The Bulloch County Board of Commissioners (hereinafter referred to as the “County”) is accepting Statement of Qualifications (SOQ) from qualified multidisciplinary consulting firms to provide professional architectural, engineering, landscape architecture, surveying, permitting, bidding, and construction administration services (“Services”) for the development of Portal Community Park.

Bulloch County Recreation and Parks has developed a preferred conceptual layout for the park and seeks a qualified consultant to refine the concept, prepare complete construction documents, obtain required permits, assist with bidding, and provide construction administration services through project completion.

The selected consultant will work collaboratively with Bulloch County Recreation and Parks Department staff to ensure the project is designed in accordance with applicable local, state, and federal requirements while remaining consistent with the Bulloch County Recreation and Parks Department vision, operational needs, and available funding.

The written RFQ documents supersede any verbal or written prior communications between the parties.

TERMS AND CONDITIONS

Disqualification: Submissions may be disqualified for: a) receipt of the submission by the County past the stated deadline;

b) any irregularities; c) failure to complete requested information correctly; or d) failure to comply with restrictions to firms.

If in the opinion of the Bulloch County Board of Commissioners, the firm is not in a position to fulfill the contract, the statement may be disqualified. The County reserves the right to waive any minor informality or irregularities.

Restrictions to Firms: No employee of Bulloch County shall have a financial interest either directly or indirectly in the purchase of or contract for any goods or services, nor in any firm, corporation, partnership, limited liability company, or any other legal entity furnishing any goods or services to Bulloch County or any of its departments. For the purposes of this provision, indirect financial interest includes, but is not necessarily limited to, the financial interest of an employee’s spouse.

Contact: Please submit all questions or concerns for this RFQ to Peyton Fuller, Procurement Director, pfuller@bullochcounty.net. All email correspondence during the question & response period must include the project identifier in the subject line of the email.

Firms are required to communicate with Bulloch County using only the email address mentioned above to clarify any part of this RFQ. Firms are forbidden from contacting elected or appointed officials or any other employee of Bulloch County. Firms shall not contact the aforementioned individuals with the intent of discussing this RFQ without the express written consent of the Bulloch County Manager. Any unauthorized contact shall not be used as a basis for responding to this RFQ and will result in the rejection of the Firm’s submittal. Questions must be received by August 20, 2026, by 2:00 PM EST. Responses will be issued August 25, 2026, by 5:00 PM EST.

Firms who obtain this RFQ from Georgia Procurement Registry website: https://doas.ga.gov/state-purchasing/georgia-procurement-registry-local-governments/gpr-overview or Bulloch County website: https//bullochcounty.net/bid-opportunities/ or from other procurement website providers are advised to re-visit the above websites to obtain any addenda which may be issued prior to the RFQ closing date of September 3, 2026 @ 3:00 PM EST. The County assumes no responsibility for Respondent’s failure to acknowledge all addenda issued.

Non-Discrimination: Bulloch County, in accordance with Title VI of the Civil Rights Act of 1964, 78 Stat. 252, 42 U.S.C.

2000d to 2000d-4 and Title 49, Code of Federal Regulations, Department of Transportation, Subtitle A, Office of the Secretary, Part 21, Nondiscrimination in Federally-assisted programs of the Department of Transportation issued pursuant to such Act, hereby notifies all bidders that it will affirmatively ensure that in any contract entered into pursuant to this mailto:pfuller@bullochcounty.net https://doas.ga.gov/state-purchasing/georgia-procurement-registry-local-governments/gpr-overview https://doas.ga.gov/state-purchasing/georgia-procurement-registry-local-governments/gpr-overview https://bullochcounty.net/bid-opportunities/ https://bullochcounty.net/bid-opportunities/ advertisement, disadvantaged business enterprises as defined at 49 CFR Part 23 will be afforded full opportunity to submit bids in response to this invitation and will not be discriminated against on the grounds of race, color, national origin, or sex in consideration for an award.

Lawsuits/Bribery: Prospective Consultants shall disclose any record of pending lawsuits, criminal violations and/or convictions, etc., conflicts of interest, or contract defaults.

Liability: The County is not liable for any cost incurred in the preparation of the submission. Nor is the County bound by any information provided unless reduced to writing and distributed as a written addendum.

Reservations: The County reserves the right to reject any or all submissions, to award in whole or in part and to waive minor immaterial defects in submissions. Negotiations will be necessary to complete the contract.

Clarification of submittals: The County reserves the right to seek clarification of any point in a respondent’s submission, or to obtain additional information.

Exceptions: Conditional submissions or those that take exception to the specifications will be considered only at the discretion of the Project Manager.

Indemnification: The Firm agrees to indemnify, hold harmless, and defend Bulloch County, its officials, and employees (hereinafter collectively “the indemnitees”) from and against any and all claims, damages, liabilities, suits, proceedings, costs, and expenses of litigation (including, without limitation, reasonable attorney’s fees) related to or arising in any way out of the performance of this RFQ, unless such is attributable to the sole negligence of the indemnitees. The indemnity obligation of the Consultant will survive the expiration or termination of this RFQ.

Correction or withdrawal of submissions, cancellation of awards: Correction or withdrawal of submissions before or after opening, or cancellation of awards or contracts may be permitted only to the extent that the Firm can show by clear and convincing evidence that a mistake of non-judgmental character was made, or where the award or cancellation is in the best interest of Bulloch County.

County Obligations: Bulloch County has a standing policy to disqualify or withhold compensation to vendors, contractors and design professionals from compensation or doing business with the County if there exists obligations to Bulloch County for any liens, ad valorem taxes, licenses or other financial remittances due to Bulloch County.

Award: Award, if made, may be with the Firm that is selected by the technical review committee based on scoring using the evaluation criteria set forth herein; however, the County reserves the right to reject any and all submissions and to waive technicalities or informalities associated with the submission, and to make the award that it deems is in the best interest of the County. The firm to whom the award is made will be notified as soon as possible. The County reserves the right to reject any submission from a Firm who has previously failed to perform properly, or to complete on time contracts of a similar nature.

1. GENERAL PROJECT INFORMATION

Bulloch County Recreation and Parks Department (BCRPD) is developing Portal Community Park on approximately

51.73 acres located at 32 Clark Street, Portal, Georgia. BCRPD has established a preferred conceptual layout for the park.

The purpose of this solicitation is to select a qualified multidisciplinary consulting team to transform the BCRPD's concept into complete, bid-ready construction documents and to provide professional services throughout bidding and construction.

The selected consultant shall review and confirm feasibility of the BCRPD's conceptual layout; recommending refinements as necessary to improve constructability, regulatory compliance, accessibility, operational efficiency, permitting, and cost effectiveness while maintaining the BCRPD 's overall vision for the project.

The new proposed park facility will serve as a vital resource for promoting health, wellness, and community engagement through recreation programming and activities.

2. DESIGN PROFESSIONAL SERVICES REQUIREMENTS

The County is seeking a Design Professional to provide all design services, including the development of plans and specifications. The Design Professional will review and confirm preferred schematic feasibility, design development, and construction documents. The Design Professional will contract with the County in a timely manner. The Design Professional shall be an individual firm fulfilling all contractual obligations and performing a minimum of seventy-five percent (75%) of the design services (exclusive of engineering and specialty consultants) in-house. An associated firm (if desired) may provide up to twenty-five percent (25%) of the design services, allowing two (2) or more firms to share in the design effort.

3. SCOPE OF SERVICES

The scope of services for this project shall include the following components that are major park elements that BCRPD intends to be included as part of this project. These amenities represent the BCRPD’s desired program and serve as the basis for preparation of construction documents. The consultant may recommend reasonable adjustments to the configuration, layout, or design to improve functionality, constructability, safety, operation efficiency, permitting, or project cost.

The proposed plan includes:

1. Three Lighted Ballfields

a. Two (2) 200-ft fenced youth regulation baseball/softball fields.

b. One (1) 280-ft fenced youth regulation baseball/softball field.

c. One (1) multipurpose athletic field 240 ft wide by 360 ft long suitable for soccer, football, and community events.

d. Sports lighting for all athletic facilities.

2. Walking Trail

a. ADA Accessibility.

b. 10 ft wide, close loop-style paved trail throughout the property with connection to Bicentennial Park located at 33 Clark Street, Portal, GA 30450.

3. Playground Area

a. Age-appropriate zones (2-5 years and 5-12 years).

b. Shade structures and safety surfacing.

c. Inclusive and ADA compliant design.

4. Pavilions

a. Covered structures with picnic tables.

b. Lighting and electrical.

c. Convenient access to nearby parking and restroom facilities.

5. Restrooms/Concessions

a. Combined concession/restroom facility serving athletic fields.

b. Additional restroom facilities serving the playground and pavilion areas.

6. Archery Range

a. Ten (10) lane outdoor regulation archery shooting range.

b. Each regulation target range adjustable from 10 to 60 yards.

c. Appropriate safety features and storage.

7. Indoor Facility

a. Regulation basketball court.

b. Bleachers.

c. Multi-purpose meeting/program rooms.

d. Restrooms, storage, and office space.

e. Mechanical, electrical, and plumbing systems.

8. Site Improvements

a. Internal roadways, parking lots, and sidewalks.

b. Utilities, stormwater infrastructure, landscaping, and irrigation.

c. Site Lighting

The selected Consultant shall prove all professional services necessary to complete the project, including, but not limited to civil engineering, architectural design, landscape architecture, structural engineering, mechanical, electrical, and plumbing engineering, surveying, geotechnical investigation, environmental permitting, utility coordination, cost estimating, preparation of technical specifications, and construction administration.

The selected Consultant shall provide all design services during the 2-Phase period.

A. Phase 1 – Project Review and Design Validation: The Consultant shall perform the following services:

a. Review the BCRPD’s conceptual park layout.

b. Conduct a kickoff meeting with Recreation Department staff.

c. Identify design refinements necessary for engineering, permitting, accessibility, constructability, and budget.

d. Develop an updated Opinion of Probable Construction Cost.

e. Confirm the project scope prior to advancement into construction documents.

B. Phase 2 – Construction Documents: The selected Consultant must prepare complete construction documents suitable for public bidding. Construction documents shall include, as applicable: cover sheet, existing conditions, demolition plans, grading plans, drainage plans, utility plans, erosion and sedimentation control plans, roadway design, parking lots, sidewalks, walking trails, landscape architecture, irrigation, athletic facilities, playground layout, building design, structural plans, mechanical plans, electrical plans, plumbing plans, site lighting, construction details, technical specifications, bid schedule, and Engineers’ Opinion of Probable Cause.

The selected Consultant shall provide or coordinate all the surveying, geotechnical, and permitting services necessary to support the final design, including boundary and topographic survey, utility investigations, geotechnical investigations, environmental documentation, permit coordination, and regulatory agency coordination.

The selected Consultant shall assist BCRPD with bidding assistance during procurement of construction services by aiding in preparation of bid documents, attendance at pre-bid conference, responses to Request for Information, preparation of addenda, bid evaluation assistance, and recommendation of award.

The selected Consultant shall provide construction administration services through project completion including conducting a preconstruction conference, reviewing shop drawings and submittals, responding to Requests for Information, conducting site observations at appropriate intervals to monitor construction progress and general conformance with the construction documents, reviewing contractor pay applications, coordination of substantial completion inspections, preparation of punch lists, final inspections, and project closeout assistance.

Upon final acceptance and payment, all construction drawings, specifications, reports, studies, and other documents prepared under the contract shall become the property of Bulloch County Recreation and Parks Department.

The County reserves the right to modify the scope of services during contract negotiations.

The final scope of services will be delivered by the County and communicated to eligible firms(s) prior to actual agreement.

4. QUALIFICATIONS REVIEW PROCESS

Selection of the Design Professional will be a multi-step process generally following the steps outlined in this RFQ.

Phase I – Qualifications Review. This RFQ is initiated for the purpose of acquiring Statements of Qualifications (SOQs) from prospective design professional firms. A selection of finalist firms will be made by an evaluation team consisting of representatives of the County and may include other qualified individuals as deemed appropriate by the County, in its sole discretion. The Evaluation Team will receive and review Responses and then evaluate the submittals based on the criteria for evaluation listed below.

Criteria for Evaluation of Statements of Qualifications

Phase I

30% Factor: Experience and Qualifications of Project Manager, Key Team Members, and Prime Consultants.

20% Factor: Resources and Workload Capacity of Project Manager, Key Team Members, and Prime Consultation

Phase II

40% Factor: Technical Approach

10% Factor: Past Performance

5. SCHEDULE OF EVENTS (PHASE I)

The following Schedule of Events represents the County’s best estimate of the schedule that will be followed.

All times indicated are prevailing times in Statesboro, Georgia. The County reserves the right to adjust the schedule as it deems necessary.

STEP I (RFQ) Estimated Timeline

Event Projected Date

Projected Time

a. County issues public advertisement of RFQ 8/06/2026 -----

b. Deadline for written questions/requests for clarification (see Section 6). 8/20/2026 2:00pm

c. Responses to written questions/requests posted to County’s website 8/25/2026 5:00pm

d. Deadline for submission of Statements of Qualifications to Bulloch County Board of Commissioners, 115 N Main Street, Statesboro GA 30458

9/3/2026 3:00pm

e. County completes evaluation, post results, and issues notifications to finalist firms to submit technical information.

9/17/2026

6. SUBMITTAL OF QUESTIONS AND REQUESTS FOR CLARIFICATION

It is the Respondent’s responsibility to examine the entire RFQ, seek clarification in writing, and review its submittal for accuracy before submitting the Response document. Once the submittal deadline has passed, all submissions will be final. The County will not request clarification from individual Respondents regarding their submissions but reserves the right to ask for additional information from all parties who have submitted Responses. Questions about any aspect of the RFQ, or the Project, shall be submitted via email, and the project identifier __FY27-CP-PARK11_ must appear in the subject line, to:

Peyton Fuller

Bulloch County

Procurement Director

Email: pfuller@bullochcounty.net mailto:pfuller@bullochcounty.net

The deadline for submission of questions relating to the RFQ is the time and date shown in the Schedule of Events (Section 5). All relevant questions and requests for clarification received by the County in writing prior to the deadline will be compiled, and answers will be posted on the County’s procurement page as an addendum to the original solicitation for services at https://bullochcounty.net/bid-opportunities/

7. INSTRUCTIONS FOR PREPARING STATEMENTS OF QUALIFICATIONS

Interested firms shall submit one (1) Original and four (4) copies of the complete Response package to Peyton Fuller, Procurement Director at 115 N Main Street, Statesboro GA 30458. Submittals must be prepared in a manner that fits a standard 8 ½” x 11” paper format. Responses are limited to using a minimum of an 11- point font. The entire Response shall not exceed twenty (20) pages, including exhibits, affidavits or other enclosure information that may be included in an appendix. All pages count regardless of content.

Submittals that include qualifications of more than one firm shall not exceed page limits. Submittals that exceed the page limit will be deemed non-responsive and will not be considered by the Evaluation Team.

STATEMENT OF QUALIFICATIONS

Emphasis should be on completeness, relevance, and clarity to content. The content of all Responses must be categorized and numbered as outlined below, and responsive to all requested information.

1. Basic Company Information

a. Company name.

b. Company headquarters address.

c. Contact information for the company’s point of contact for this solicitation.

d. Company website, if available.

e. Address for offices located in the State of Georgia.

f. Staff – number and disciplines of staff members employed in each office in Georgia.

g. Ownership – state of residence or incorporation, number of years in business, and form of ownership.

h. Immigration and Security Form (provided) for Prime.

2. Experience and Qualifications

a. Project Manager and key members needed to meet the needs of the project. Please provide the following information for all key members

i. Education.

ii. Registration

iii. Relevant project engineering experience.

iv. Relevant project management experience for project managers.

3. Prime Consultant Experience – Provide information on prime consultant’s experience and ability in delivering effective services for projects of similar complexity, size, scope, and function. Describe no less than three (3) but no more than five (5) projects in order of most relevant to least relevant, which demonstrate the consultant’s capabilities to provide services. For each project, the following information should be provided:

a. Client name and contact information, project location, and dates during which services were performed.

b. Description of project and services performed by your firm.

c. Duration of project services provided by your firm and overall project budget.

d. Experience using processes described in the scope and design standards

e. Involvement of key team members on the projects

4. Notice of Professional Sub-consultants – provide list of all sub-consultants that prime intends to utilize on this project.

5. Resources/Workload Capacity – Provide information regarding the overall resources dedicated to delivering the project, including:

a. Organizational chart identifying the project manager, prime consultant, all key team members, support personnel, and reporting structure.

b. Primary Office – Identify and discuss primary office that will be responsible for handling the specific project, number and types of staff within the office, and how this office could benefit the project and promote efficiency.

c. Additional Resource Areas and Ability (maximum one page) – Provide information regarding any additional resource areas identified as important to the project, discuss how key areas will integrate and work together on the project, and how the team can deliver the project on schedule given their workload capacity. Advantages of your team and abilities of team members which will enable the project to meet proposed schedule may be discussed.

d. Project Manager and Key Team Members Commitment Table – Provide a list of all projects on which the proposed project manager and other key team members are currently committed to enable the County to ascertain availability of project manager and key team members.

8. SUBMITTAL OF STATEMENTS OF QUALIFICATIONS

The SOQ must be submitted in a sealed envelope to the following address:

Bulloch County Commissioners 115 N Main St.

Statesboro, GA 30458

The outside of the sealed envelope shall contain the wording: Portal Park Design Project SOQ Phase I; Due Date:

September 3, 2026 @ 3:00pm; Attn: Procurement Director.

Respondents will be fully responsible for the delivery of their SOQs by due date and time as stated in the RFQ Estimated Timeline Schedule. Reliance upon U.S. Mail or other carriers is at the respondent's risk. No faxes or emails will be accepted. Late submittals will not be considered.

All expenses for preparing and submitting Responses are the sole cost of the firm submitting the Response.

The County is not obliged to any party to reimburse such expenses.

All submittals upon receipt become the property of the County. Labeling information provided in submittals “proprietary” or “confidential” or any other designation of restricted use may not protect the information from public view. Subject to the provisions of the Open Records Act, the details of the Response documents will remain confidential until final award. All Responses shall be documents subject to the Georgia Open Records Act and public documents. Any information constituting trade secrets contained in the Response shall be so indicated with an affidavit in compliance with Section 50-18-72(a)(34) of the Official Code of Georgia Annotated; however, a general indication that the entire contents, or a major portion, of the Response is trade secrets will not be honored. A final decision as to the exemption of documents identified as trade secrets from the Open Records Act shall be in the full discretion of the County.

9. FINALIST NOTIFICATION

Upon submission of the requested information, the County’s review team will review and score the submissions using the described above. Phase I will score Experience and Qualifications as well as Resources and Workload Capacity. Firms that are selected for Phase II will provide Technical Approach and Past Performance information. Prior to the final selection, the Recreation Director may require submittal of further documentation regarding the firm’s capabilities and qualifications. The information will be presented in summary form, and a recommendation will be made to the County Manager and the Bulloch County Board of Commissioners for a final selection and authorization to negotiate a contract.

Phase II- Design Professional Selection will be initiated by invitation to finalists to submit Technical Approach and Past Performance information. Finalists will be those firms determined by the Evaluation Team to be especially qualified to perform as the Design Professional for this Project in accordance with the qualification criteria herein. The successful Design Professional will be determined from responses. The selected firms shall provide proof of purchase from and maintain with a company or companies authorized to do business in the state of Georgia the following types of insurance:

A. Statutorily required workers’ compensation insurance.

B. Commercial general liability insurance, with an endorsement naming the County and its officials, officers, and employees as an additional insured, and with limits of not less than $1,000,000.00 per occurrence and $2,000,000.00 aggregate.

C. Motor vehicle liability insurance with limits of not less than $1,000,000.00 for bodily injury to or death of one person in any one accident, and not less than $2,000,000.00 because of bodily injury to or death of two or more persons in any one accident; and not less than $250,000.00 because of injury to or destruction of property.

Mandatory Forms

The following pages are the forms that must be submitted in the RFQ along with all other information asked for in this RFQ. All items requiring signatures must be signed and all items requiring a notary must be notarized. Failure to return any of the items or incorrectly completed items on the following pages will be justification for non-acceptance of the SOQ as non-responsive.

FORM A: NON-COLLUSION AFFIDAVIT

STATE OF:

COUNTY OF:

Owner, Partner, or Officer of Firm:

Company Name, Address, County and State:

Being of lawful age and being first duly sworn, the above-named individual on oath says that he/she is the agent authorized by the vendor to submit the attached proposal. Affiant further states that neither the vendor nor any of its employees or agents has prevented or attempted to prevent competition in such bidding by any means whatever; nor has the vendor or any of its employees or agents prevented or endeavored to prevent anyone from making a bid or proposal therefor by any means whatever; nor has the vendor or any of its employees or agents caused or induced another to withdraw a bid or proposal for the work. Affiant further states that neither the vendor nor any of its employees or agents has directly or indirectly violated Section 36-91-21(d) of the Official Code of Georgia Annotated.

FIRM NAME ____________________________________________________________

SIGNATURE ___________________________________________________________

TITLE ___________________________________________________________

Subscribed and sworn to before me this _____ day of _______________ 20____.

NOTARY PUBLIC _____________________________________

FORM B: RESPONDENT’S DECLARATION

The respondent understands, agrees and warrants:

That the respondent has carefully read and fully understands the full scope of the specifications.

That the respondent has the capability to successfully undertake and complete the responsibilities and obligations in said specifications.

That this SOQ shall be valid for 60 days.

That this SOQ may be withdrawn by requesting such withdrawal in writing at any time prior to September 3, 2026, 3:00 PM EDT but may not be withdrawn after such date and time for a period of 60 days.

That Bulloch County reserves the right to reject any or all SOQs and to accept that SOQ which will, in its opinion, best serve the public interest. Bulloch County reserves the right to waive any technicalities or informalities in the solicitation.

That by submission of this SOQ the Respondent acknowledges that Bulloch County has the right to make any inquiry or investigation it deems appropriate to substantiate or supplement information supplied by the respondent.

If a partnership, a general partner must sign.

If a corporation the authorized corporate officer(s) must sign and the corporate seal must be affixed to this proposal.

RESPONDENT:

Name Title

Name Title

AFFIX CORPORATE SEAL (if applicable)

Subscribed and sworn to before me this _____ day of _______________ 20____.

NOTARY PUBLIC _____________________________________

FORM C: Contractor Affidavit under O.C.G.A. § 13-10-91(b)(1)

By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of Bulloch County, Georgia has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91. Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A. § 13-10-91(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization E-verify Company ID# Date of Authorization

Name of Company

Name of Contractor

Portal Park Design Project Name of Project

__Bulloch County, Georgia___________ Name of Public Employer

I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on ____________, _____, 20____ in ________________ (city), ____ (state).

Signature of Authorized Officer or Agent

Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME

ON THIS THE ______ DAY OF _________________,20____.

NOTARY PUBLIC

My Commission Expires:

* As of the effective date of O.C.G.A. § 13-10-91, the applicable federal work authorization program is the "EEV/Basic Pilot Program" operated by the U.S. Citizenship and Immigration Services Bureau of the U.S. Department of Homeland Security, in conjunction with the Social Security Administration (SSA).

FORM D: Subcontractor Affidavit under O.C.G.A. § 13-10-91(b)(3)

By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with (enter name of contractor) on behalf of Bulloch County, Georgia has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91.

Furthermore, the undersigned subcontractor will continue to use the federal work authorization program throughout the contract period and the undersigned subcontractor will contract for the physical performance of services in satisfaction of such contract only with sub-subcontractors who present an affidavit to the subcontractor with the information required by O.C.G.A. § 13-10-91(b). Additionally, the undersigned subcontractor will forward notice of the receipt of an affidavit from a sub-subcontractor to the contractor within five business days of receipt. If the undersigned subcontractor receives notice that a sub-subcontractor has received an affidavit from any other contracted sub-subcontractor, the undersigned subcontractor must forward, within five business days of receipt, a copy of the notice to the contractor. Subcontractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization E-verify Company ID# Date of Authorization

Name of Subcontractor

Portal Park Design Project Name of Project

Bulloch County, Georgia Name of Public Employer

I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on ______, ___, 20__ in _____(city), _____(state).

Signature of Authorized Officer or Agent

Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME

ON THIS THE ______ DAY OF ______________,20__.

NOTARY PUBLIC

My Commission Expires: